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A New Book on Islamic Medicine:Medieval Islamic Medicine by Peter E. Pormann and Emilie Savage-Smith

Medieval Islamic Medicine by Peter E. Formann and Emilie Savage-Smith is a new book on the Islamic medical tradition, published by Edinburgh University Press. This review reproduces the introduction and the conclusion of the book, with some supplementary data, such as the table of contents and purhase information.

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Figure 1. The cover page of the "Medieval Islamic Medicine" book.

Medieval Islamic Medicine by Peter E. Formann and Emilie Savage-Smith is a new book on the Islamic medical tradition, published by Edinburgh University Press. In the following we reproduce for our readers the introduction and the conclusion of the book, with some supplementary data, such as the table of contents and purhase information.

The book provides a new analysis that takes a fresh approach to the history of medical care in the lands of Islam during the medieval period (c. 650–1500). Drawing on numerous sources, many previously unpublished, the authors explore the development of medicine across the social spectrum, comparing and contrasting medical theories and treatises with evidence of actual practices, as well as folkloric and magical medical traditions. It is the story of contact and cultural exchange across countries and creeds, affecting many people from kings to the common crowd. In addition to being fascinating in its own right, medieval Islamic medicine formed the roots from which modern Western medicine arose. Contrary to the stereotypical picture, it was not simply a conduit for Greek ideas, but a venue for innovation and change.

Taking a thematic rather than a chronological approach, the book is organized around five topics: the emergence of medieval Islamic medicine and its intense cross-pollination with other cultures; the theoretical medical framework; the function of physicians with the larger society; medical care as seen through preserved case histories; and the role of magic and devout religious invocations in scholarly as well as everyday medicine. A concluding chapter on the ‘afterlife' concerns the impact of this tradition on modern European medical practices and its continued practice today. The book (223 pages) includes 22 black-and-white illustrations, a map, an index of historical figures and their writings, a general index, a comprehensive bibliography, a timeline of developments in the ‘East' and the ‘West', and chapter-by-chapter annotated bibliographic essays.

The medical tradition that developed in the lands of Islam during the medieval period has, like few others, influenced the fates and fortunes of countless human beings. It is the story of contact and cultural exchange across countries and creeds, affecting caliphs, kings, courtiers, courtesans, and the common crowd. In addition to being fascinating in its own right, medieval Islamic medicine is also important because of its influence on Europe where it formed the roots from which modern Western medicine arose. To be sure, the earlier Graeco-Roman scholarly medical literature was the stem from which much Islamic medicine grew, just as, several centuries later, Islamic medicine was to be the core of late medieval and early European medical education. As will be seen in the following chapters, however, medieval Islamic medicine was not simply a conduit for Greek ideas, which is the stereotypical picture, but it was a venue for innovation and change.

The geographical contours of the medieval Islamic world extended from Spain and North Africa in the west to Central Asia and India in the east, with the central lands of Egypt, Syria, Iraq and Persia playing a pivotal role. In temporal terms it covered a period of roughly nine centuries – from the middle of the seventh to the end of the fifteenth century, by which time it had broken up into three distinct empires, the Ottoman, the Safavid, and the Mughal. For the purposes of this study, our consideration of medieval Islamic medicine will not extend past the emergence of the Safavid empire in Persia (modern Iran) and the Mughal empire in India, both of which coincided with the golden age of the Ottoman empire, centred in Turkey. The Ottoman dynasty in fact arose at the end of the thirteenth century, but the theoretical and practical approaches to medicine in the areas under its domain during the first two centuries of its existence firmly belonged to the medieval Islamic medical tradition. In the sixteenth century, however, the courts of the three empires came into contact with the courts of Europe. With new commercial and military undertakings and increased travel between Europe and the Middle East, medical education and practice began to change subtly. This `transitional' medicine between the medieval and the early modern will only be lightly touched upon in our final chapter.

Figure 2. Emilie Savage-Smith.

The medical needs and practices of the medieval Islamic world over such a vast area and time-span of nine centuries were of course neither uniform nor unchanging. The everyday medieval practices and the general health of the Islamic community were influenced by many factors: the dietary and fasting laws as well as the general rules for hygiene and burying the dead of the various religious communities of Muslims, Jews, Christians, Zoroastrians, and others; the climatic conditions of the desert, marsh, mountain, and littoral communities; the different living conditions of nomadic, rural, and urban populations; local economic conditions and agricultural successes or failures; the amount of travel undertaken for commerce, for attendance at courts, or as a pilgrimage; the maintenance of a slave class and slave trade; the injuries and diseases attendant upon army camps and battles; and the incidence of plague and other epidemics as well as the occurrence of endemic conditions such as dysenteries and certain eye diseases.

The institutions and policies responsible for dispensing medical care were subject to political and social fluctuations. Moreover, the medical practices of the society varied not only according to time and space, but also according to class. The economic and social level of the patient determined to a large extent the type of care sought, just as it does today, and the expectations of the patients varied along with the approaches of the practitioners. Throughout medieval Islamic society a medical pluralism existed that may be viewed as a continuum running from the scholarly theories and practices of learned medicine to those of local custom and magic. Woefully little evidence is available as to the patient's perspective in all of this, but we have tried in this volume to tease out a few pertinent testimonies.

The medieval Islamic community comprised Muslims and non-Muslims speaking many languages: Arabic, Persian, Syriac, Hebrew, Turkish, and various local dialects. Islam became the dominant faith, and Arabic (the language of the Qur'an) served as the lingua franca, a common language for all educated and official discourse, much as Latin did in Europe for several centuries. Use of the Arabic language enabled a mix of diverse peoples speaking different languages to communicate with one another. Thus, whether the authors were Persian or Arab, Jewish or Christian, and whether they spoke Greek, Syriac, or Turkish, for the most part they wrote in Arabic. The resulting medical literature and medical practice involved a rich and diverse mixture of religions and cultures to be seen in both the physicians and the patients. For this reason, the term `Islamic culture' or `Islamic medicine', in this context, is not to be interpreted as applying only to the religion of Islam.

The aim of this book is not to compress the entire history of medieval Islamic medicine into a single small volume. Rather, it presents an overview, highlighted with particular examples. The volume also incorporates a considerable amount of hitherto unpublished material (details of which are given in the endnotes), which in many instances has allowed us to expand our perceptions of the medical care at that time. Because so many topics have yet to receive proper scholarly attention, we are still in no position to undertake a comprehensive history of medicine in the Muslim World, even when limiting it to the medieval Islamic period. Nonetheless, we did wish to address some aspects of the social history of medicine, such as female patients and practitioners, hospitals, public health care, rural and urban provisions, medical ethics and education, and so on. Moreover, we wanted to tackle the problem of how patients were actually treated, rather than simply confining ourselves to a description of the medical theory and a chronology of famous physicians.

We have organised the essay around five major topics, reflected by the titles of the first five chapters: (1) the emergence of medieval Islamic medicine and its intense cross-pollination with other cultures, notably by way of translation, but also by trade and travel; (2) the theoretical medical framework and extensive literature that guided learned doctors in their work; (3) how physicians from various backgrounds functioned within the larger society; (4) what case histories tell us about the application of medical practices to specific patients and what remedies they really resorted to; and (5) the role of magical therapies, folkloric traditions and devout religious invocations in scholarly as well as everyday medicine. The sixth, and final, chapter is on the `afterlife' of medieval Islamic medicine – that is, how it came to form the basis of the European medical tradition and how medieval Islamic medicine continues to be practiced today. It should be noted that treatments for animals – horses, camels, falcons, domestic animals of various sorts – are not included amongst the subjects of this book, though medieval Arabic and Persian treatises exist on many such topics. Here, we are concerned only with humans and their attempts to understand and regulate their health and well-being.

The medical tradition which we describe in this book is intimately linked to the European one. It had its origin primarily in parts of the Greek-speaking world located in modern Turkey and Egypt, and it subsequently greatly contributed to late medieval and renaissance medicine in Europe. This constant movement of ideas between the different shores of the Mediterranean belies the dichotomy of `East' and `West'.

Late medieval and early Renaissance European medical education owed much to the medieval Islamic medical tradition. In fact the debt was so great that the history of medieval Islamic medicine is in essence the history of the origins of early modern Western medicine. Of course it must be stressed that, following the absorption in Europe of Arabic medical writings (and the Greek medicine that they also contained), medical theory as well as anatomical and pathological knowledge changed radically, particularly in the nineteenth and twentieth centuries. Yet the origins of the approaches and methodology of modern Western medicine can be traced in large part to medieval Islamic medicine (in its Latin garb), while the institutionalisation of both teaching and the provision of medical care was foreshadowed by Islamic institutions.

Figure 3. Peter E. Pormann.

While some elements of medieval Islamic medicine can be viewed as forerunners of modern practices, other features may seem strange, or quaint, or even irrelevant to the modern world. Magical procedures, folkloric practices of local custom, and devout religious measures formed as much a part of the society's reaction to pain and illness as did those elements we now consider more `rational'. A modern reader should not approach medieval Islamic medicine with an attitude of amused indulgence or contempt, nor should one hunt the present in the past.

In the last part of this introduction, it is necessary to place the present project in the context of previous scholarship. In 1968 Manfred Ullmann finished the manuscript of his monumental Die Medizin im Islam, which set the agenda for all subsequent research into the topic. In it, he deliberately chose not to write a history of medicine, but rather to survey the evidence available in manuscripts, printed sources, and secondary literature. In his much shorter and more discursive Islamic Medicine completed in 1976, he specifically excluded a number of topics from his discussion, because of the `state of contemporary research'. These included `surgery and hospital institutions', and `the doctor's social standing, the doctor-patient relationship, [and] medical teaching' [1]. Some thirty years later, we are in a slightly better position to deal with these subjects, for scholars such as the late and lamented Michael W. Dols, as well as Cristina Álvarez-Millán, Lawrence I. Conrad, and Avner Gil'adi, have tackled different social and practical aspects of the history of medicine in the medieval Islamic world. We are, nonetheless, profoundly indebted to Manfred Ullmann, whose earlier volume of Islamic Medicine was published in the Islamic Surveys by the Edinburgh University Press. The volume we have written is intended not to replace it, but to succeed and supplement it, focusing upon issues and topics that at the time of the first volume were not sufficiently studied by scholars to permit even a preliminary survey.

In the course of the following six chapters, we hope to reveal complexities and contradictions encourage comparisons, raise –and perhaps to offer a few answers to – questions such as: How did Islamic medieval writers arrive at such a high standard of medical knowledge and such successful treatments? What was the position of the physician in medieval Islamic society and how did one become a physician? How do the many theoretical treatises relate to the actual practice of medicine? What role did the Islamic hospitals play in the provision of medical care and in the education of physicians?

The diversity of medieval Islamic society is so great that it cannot be painted but with a broad brush. We hope that our picture of medical theory and practice in medieval Islam, given the limited sources presently at hand, is sound and not too far off the mark.

Suggested reading

For general surveys of Islamic medicine, see our predecessor volume Ullman, Islamic Medicine; Conrad, `The Arab-Islamic Medical Tradition'; E. Savage-Smith, `Tibb', EI' x. 452-460; Savage-Smith, `Medicine'; Haskell, `Arabic Medical Literature'; Strohmaier, `Reception and Tradition'; and the long introduction to Dols, Medieval Islamic Medicine. For medicine in Muslim Spain, the volume edited by Maribel Fierro and Julio Samsó is a good starting point (Fierro and Samsó, The Formation of al-Andalus, Part 2). Still useful, but to be used with some cuation, are Plessner, `Natural Sciences and Medicine' and Browne, Arabian Medicine.

For individual figures, as well as topics, see the comprehensive bibliography by Ullmann, Medizin im Islam, as well as that by Sezgin, Medizin-Pharmazie. For major figures and topics, the corresponding entries in the Encyclopaedia of Islam, both the printed second edition and its more recent on-line version, are invaluable, as are the articles in the Encyclopedia Iranica, which is still in the course of publication. The website `Islamic Medical Manuscripts at the National Library of Medicine' (in Bethesda, Maryland, USA, http://www.nlm.nih.gov/hmd/arabic) also provides useful biographies of authors and short essays on types of medical writings [2].

Conclusion

Medieval Islamic scholars made the rich intellectual traditions of older cultures around them – particularly that of ancient Greece – serve their own purposes, much as Renaissance thinkers were later to do when they encountered Greek culture first hand. Yet, were they innovative? Some scholars in the West from the Renaissance onwards have denied this, saying that Muslims only copied and transmitted what others had done before them. We have seen, however, that Islamic physicians, while maintaining great respect for authority of ancient texts, at the same time often tested and challenged their precursors. Of those whom we can document, al-Razi is perhaps the most outstanding example of this analytical and questioning attitude. In our opinion, it is impossible to read the comments of this great clinician struggling to find a way of determining the true efficacy of a treatment recommended in antiquity as useful, or writing an essay on his doubts about Galen, or differentiating between measles and smallpox, and not to be impressed by the intelligence and originality at work. Lesser luminaries made their contributions as well during the millennium covered in this rapid survey. They described new medicinal substances, recognised new pathological conditions (even if they overlooked others that we feel with hindsight they ought to have spotted), illustrated the design of surgical instruments (obvious to us today, but entirely novel at the time), and vastly expanded the options available to a physician when treating patients.

Innovation was not, however, restricted to challenging authority and discovering new diseases and treatments. Undoubtetdly one of the greatest success-stories was the Canon of Medicine by Ibn Sina, as well as other medical compendia, which skilfully organised the medical precepts and principles. One might even say that they were too skilfully organised, for some physicians (both European and Islamic) were so impressed by the methodically construed system that they may have thought it required no further elaboration or development. The commentaries written on the Canon, however, could contain new insights, such as the discovery of the pulmonary transit by Ibn al-Nafis, and commentaries in general provided a forum in which learned physicians could modify and debate issues.

The medieval Islamic community displayed its creativity, and applied the ethical principles of Islam, through another major avenue as well, namely what we would today label as `public health care'. The extraordinary provision of public bath-houses, complex sanitary systems of drainage (more extensive even than the famous Roman infrastructures), fresh water supplies, and the large and sophisticated urban hospitals, all contributed to the general health of the population. In addition, it was an unprecented initiative that the same physicians who treated the social and political elite also taught, practised, and observed the effects of various therapies in hospitals where the poor received medical care. Finally, although the evidence is sparse, it appears that at various times and places authorities set about to regulate, in one way or another, the performance and competency of those providing medical care or active in the medical market-place.

Medieval Islamic medicine, in all its diversity, emerged as a complex cluster of theories and practices. Two questions remain to be addressed: why did this multi-faceted tradition emerge when and where it did, and why do certain aspects of it still prove attractive to peoples in many parts of the world? With regard to the first question, openness to foreign cultures often engenders an atmosphere of creativity and growth, and medieval Islamic society tolerated other customs and confessions to a much larger degree than its medieval Christian counter-parts. In particular, its medical tradition thrived through an infusion of outside influences. In the context of learned medicine, the underlying medical principles were secular and therefore permitted peoples of divergent backgrounds and beliefs to cooperate and to participate in a joint scientific discourse.

As for the second question, the basis medical system – inherited in its essence from Greece, but vastly expanded and developed in Islamic lands – was what we would today term `holistic'. The overriding concern was for the improvement of the patient through manipulation of environmental factors, regimen, and diet. When those proved insufficient, medicaments were applied or taken internally. Intervention was kept to a minimum. This approach resonates with many current trends in medical care.

Throughout this book we have had to rely, regrettably, upon evidence that is often fragmentary and sometimes contradictory. Occasionally there is just a casual remark that provides only a brief or partial glimpse into what was occurring. It is left to us to speculate as to how to connect the dots between these disparate bits of evidence. Sometimes our generalities may have been too sweeping. In others we may have been too constrained. Our study has not been exhaustive, for there are a number of topics that could have been explored but have not been. In regard to many of the subjects we raised, much more evidence could have been presented and analysed than space permitted here. Our overall aim has been to draw not a comprehensive or detailed picture, nor just a skeletal outline of medieval Islamic medicine, but one that had some muscle and flesh on the basic structures, relying throughout on a fresh examination of the sources as well as the most recent scholarly studies. The end result, we hope, is a picture of a vibrant and varied society, one in which the medical care was not monolithic but rather configured with many shades and textures.

For purchases in the Middle East, it is published by The American University in Cairo Press (ISBN: 978-977-416-070-7), $27.50 paperback. To order: fax +202 794 1440 or http://www.aucpress.com.

Emilie Savage-Smith is Professor of the History of Islamic Science at the Oriental Institute and a senior research fellow of St Cross College, both at the University of Oxford. Recent books include A Descriptive Catalogue of Oriental Manuscripts at St John's College, Oxford (2005), Magic and Divination in Early Islam (2004), Medieval Views of the Cosmos (2004) and Science, Tools and Magic (1997).

Peter E. Pormann is a Wellcome Trust Lecturer in the Department of Classics and Ancient History at the University of Warwick. He studied in Paris (Sorbonne), Hamburg, Tübingen and Leiden, and received a D. Phil. From the University of Oxford in 2002. He won the Hellenic Foundation's 2003 Award for the best doctoral thesis in the United Kingdom, in the Byzantine/Medieval History category, and is the author of The Oriental Tradition of Paul of Aegina's 'Pragmateai' (2004).

Bibliography

In order to orient the reader, we reproduce hereinafter the complete bibliographic references to these works in the same order in which they are given by the authors: